Medical education in India, looking for ’achhe din’

The future of India’s health status and healthcare appears to be beyond bleak if one were to just glance at the health human resource crunch and a seemingly ostensible indifference in addressing this crisis.

India has just about seven doctors per 10,000 persons, as against a Russia which has 43.1 doctors per 10,000; USA has 24.5 and Brazil 18.9 per 10,000.

At a very simplistic level, this indicates that India currently has a deficit of approximately 300,000 doctors, and when compared to the annual supply of only 44,300 MBBS graduates, it is a confounding comparison.

So, how does India plan to address this situation? What is it doing to ramp up the number of doctors? At present, it seems, not much.

Till now, it appears to be long winded saga of recommendations, amendments, standing committees and now an unfortunate disapproval of plans is a succinct status of a beleaguered process that began even before Independence! The Medical Council of India (MCI) was established in 1934 under the Indian Medical Council Act, 1933, as an elected body for maintaining the medical register and providing ethical oversight, with no specific role in medical education.

Over the decades, its performance has been short of optimal. In the face of rampant corruption observed especially over the last few years, the role of MCI was taken up by the Parliament.

In March 2016, the report of the Parliamentary Standing Committee on the need to reform The Medical Council of India came as a glimmer of hope.

The committee observed that the Medical Council of India, when tested on the core reason of its existence, has been a under performer.

It said that the quality of medical education is at its lowest ebb; medical graduates lack competence in performing basic health care tasks like conducting normal deliveries; instances of unethical practice continue to grow due to which respect for the profession has dwindled, and yet, the MCI has not been able to introduce any serious reforms in medical education to address these gaps.

It went on to add that it is of the view that there is too much power concentrated in a single body (i.e. the MCI), and it has failed to create a transparent system of licensing of medical colleges.

The committee, therefore, favoured a bifurcation of the functions of MCI and recommended that different structures be created for discharging different functions.

According to a KPMG report on the health manpower crunch, the situation is such that India needs to commission 550 medical colleges – 100 seats per college right away to meet the global average by 2030.

A step such as this alone can help India cope with its burgeoning population, mounting disease burden and escalating economic burden on account of ill health of its populace.

Subsequent to the Parliamentary Standing Committee’s report, in March 2016, the Supreme Court constituted a three-member committee headed by former Chief Justice of India R M Lodha to oversee the Medical Council of India.

The MCI protested against the establishment of the Lodha Committee and said that lobbies with ulterior motives and interests had done everything possible in their attempts to malign its reputation.

Alongside, a deep seated malaise of MCI raised its ugly head once again, one of unabated disapprovals of applications for medical colleges, addition of seats, renewals of permissions and recognitions.

In an unprecedented recent development, the MCI disapproved almost 94 percent applications that came in from the private sector to establish new medical college, i.e. 74 applications were disapproved as against the 79 applications that MCI had received in 2016-17.

This translates into a loss of almost 8000 doctors for India.

Furthermore, almost 87 percent of the requests for new seats were disapproved.

Strangely, even the applications that came in from the government were not spared, their applications for new colleges and new seats too were disapproved in a large percentage.

The reasons for these disapprovals are unknown and possibly are trivial.

Thankfully, Justice Lodha gave amnesty to over 175 private medical colleges who were denied approval this year and also chance to re-submit their representations to the health.

This was an encouraging move, but it has been over 100 days since the Lodha Committee was commissioned and we are yet to hear of plans for the future of medical education in India.

A proposal to replace the MCI with a National Commission for Human Resources in Healthcare (NCHRH) has been on the horizon since 2009, but a bill on these lines was rejected by the parliamentary standing committee in 2012.

Will the nation revisit the decision? India now only looks towards the Lodha Committee to bring forth ‘achhe din’ for medical education and a healthier India.